Compliance Regulations and Guidance Affecting your Industry

To establish common criteria, based on “one day in ten year” loss of Load expectation principles, for the analysis, assessment and documentation of Resource Adequacy for Load in the ReliabilityFirst Corporation (RFC) region

This standard defines a process for monitoring Balancing Authorities to ensure that, over the long term, Balancing Authority Areas do not excessively depend on other Balancing Authority Areas in the Interconnection for meeting their demand or Interchange obligations

Effective Date:This rule is effective May 1, 2006

This standard establishes requirements for Balancing Authority Automatic Generation Control (AGC) necessary to calculate Area Control Error (ACE) and to routinely deploy the Regulating Reserve. The standard also ensures that all facilities and load electrically synchronized to the Interconnection are included within the metered boundary of a Balancing Area so that balancing of resources and demand can be achieved

To maintain Interconnection frequency within a predefined frequency profile under all conditions (i.e. normal and abnormal), and to ensure that Time Error Corrections are effectively conducted in a manner that does not adversely affect the reliability of the Interconnection.

Effective Date: This rule is effective April 4, 2003

The purpose of this standard is to ensure that Time Error Corrections are conducted in a manner that does not adversely affect the reliability of the Interconnection.

Effective Date: This rule is effective April 1, 2005

This standard provides a consistent method for calculating the Frequency Bias component of ACE.

Effective Date: This rule is effective May 13, 2009

Contingency Reserve is required for the reliable operation of the interconnected power system. Adequate generating capacity must be available at all times to maintain scheduled frequency, and avoid loss of firm load following transmission or generation   contingencies. This generating capacity is necessary to replace generating capacity and energy lost due to forced outages of generation or transmission equipment

The purpose of the Disturbance Control Standard (DCS) is to ensure the Balancing Authority is able to utilize its Contingency Reserve to balance resources and demand and return Interconnection frequency within defined limits following a Reportable Disturbance. Because generator failures are far more common than significant losses of load and because Contingency Reserve activation does not typically apply to the loss of load, the application of  DCS is limited to the loss of supply and does not apply to the loss of load.

Effective Date: This rule is effective April 1, 2005
 

To maintain Interconnection steady-state frequency within defined limits by balancing real power demand and supply in real-time.

Effective Date: This rule is effective May 13,2009

This bill eliminates provisions of law that allow health plans to charge different premiums, prices, or charges, based on gender. The bill’s provisions apply to contracts issued, amended, or renewed on or after January 1, 2011.

This bill prohibits a health plan or health insurer from rescinding an individual health plan contract or individual health insurance policy for any reason, or from canceling, limiting, or raising the premiums of the plan contract or policy due to any omission, misrepresentation, or inaccuracy in the application form, after 24 months following the issuance of the plan contract or policy, except as specified.

This bill requires heath care service plans and health insurers to provide notice of the availability of premium assistance under the federal American Recovery and Reinvestment Act of 2009 to qualified beneficiaries, as specified. The bill allows a qualified beneficiary eligible for the federal premium assistance to elect Cal-COBRA coverage within a certain period of time, as specified. This bill allows individuals enrolled in Cal-COBRA coverage as of February 17, 2009, to request application of the federal premium assistance, as specified

This rule finalizes our proposal to rescind the December 28, 2007 final rule entitled, ‘‘Elimination of Reimbursement under Medicaid for School Administration Expenditures and Costs Related to Transportation of School-Age Children Between Home and School;’’ the November 7, 2008 final rule entitled, ‘‘Clarification of Outpatient Hospital Facility (Including Outpatient Hospital Clinic) Services Definition;’’ and certain provisions of the December 4, 2007 interim final rule entitled, ‘‘Optional State Plan Case Management Services.’’ These regulations have been the subject of Congressional moratoria and have not yet been implemented (or, with respect to the case management interim final rule, have only been partially implemented) by CMS. In light of concerns raised about the adverse effects that could result from these  regulations, in particular, the potential restrictions on services available to beneficiaries and the lack of clear evidence demonstrating that the approaches taken in the regulations are warranted, CMS is rescinding the two final rules in full, and partially rescinding the interim final rule. Rescinding these provisions will permit further opportunity to determine the best approach to further the objectives of the Medicaid program in providing necessary health benefits coverage to needy individuals.

Effective Date: These regulations are effective on July 1, 2009.

This final rule sets forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health services. In addition, this final rule sets forth policy changes related to Medicare payment for certain durable medical equipment for the purpose of implementing sections 1834(a)(5) and 1834(a)(7) of the Social Security Act, as amended by section 5101 of the Deficit Reduction Act of 2005. This final rule also responds to public comments on the August 3, 2006, proposed rule that pertain to a number of issues including  the requirement that home health payments are based on the reporting of specific quality data by home health agencies.

Effective Date: These regulations are effective on January 1, 2007.

This document contains final rules for group health plans and health insurance issuers concerning hospital lengths of stay for mothers and newborns following childbirth, pursuant to the Newborns’ and Mothers’ Health Protection Act of 1996 and the Taxpayer Relief Act of 1997.

Effective Date: These final regulations are effective December 19, 2008.

This document contains final rules for group health plans and health insurance issuers concerning hospital lengths of stay for mothers and newborns following childbirth, pursuant to the Newborns’ and Mothers’ Health Protection Act of 1996 and the Taxpayer Relief Act of 1997.

Effective Date: These final regulations are effective December 19,2008.

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capitalrelated costs of acute care hospitals to implement changes arising from our continuing experience with these systems, and to implement certain provisions made by the TMA, Abstinence Education, and QI Program Extension Act of 2007, the Medicare Improvements for Patients and Providers Act of 2008, and the American Recovery and Reinvestment Act of 2009. In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capitalrelated costs. These changes are applicable to discharges occurring on or after October 1, 2009. We also are setting forth the update to the rate-ofincrease limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2009. Second, we are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for rate year (RY) 2010, including responding to public comments received on a June 3, 2009 supplemental proposed rule relating to the proposed RY 2010 Medicare Severity Long-Term Care Diagnosis- Related Groups (MS–LTC–DRG) relative weights and the proposed RY 2010 highcost outlier (HCO) fixed-loss amount. In the Addendum to this final rule, we also set forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS for RY 2010. These changes are applicable to discharges occurring on or after October 1, 2009. In addition, we are responding to public comments received on and finalizing a June 3, 2009 interim final rule with comment period that revised the MS–LTC–DRG relative weights for payments under the LTCH PPS for the remainder of FY 200 (that is, from June 3, 2009, through September 30, 2009). Third, in this final rule, we are responding to public comments we received on, and finalizing, two May 2008 interim final rules with comment period that implemented certain provisions of section 114 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA, Pub. L. 110–173) relating to payments to LTCHs and LTCH satellite facilities, the establishment of LTCHs and LTCH satellite facilities, and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. Fourth, through an interim final rule with comment period as part of this document, we are implementing those provisions of the ARRA that amended certain provisions of section 114 of the MMSEA relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS.

Effective Date: These final rules are effective on October 1, 2009

In addition to the statutes passed by the Legislature, the Department of California Managed Healthcare has enacted a number of regulations under which health care plans must operate. These regulations help to bring some detail and clarity to the manner in which health plans must comply with the statutes enacted by the Legislature.

The Knox-Keene Health Care Service Plan Act (Knox-Keene Act), provides licensure and regulation of health care service plans. It also provides regulation of health insurers by the Department of Insurance and requires insurers to obtain a certificate of authority from the Insurance Commissioner. The bill would also authorize a joint venture formed between 2 or more nonprofit charitable organizations to contract with a health care service plan or health insurer for the purpose of providing health care coverage to the employees and retirees, and dependents thereof, of the participating nonprofit charitable organizations.
 

The Department of Managed Health Care proposed Title 28, California Code of Regulations, Timely Access to Non-Emergency Health Care Services to provide a better and quality service to the patients.